1. Field of the Invention
Embodiments presented herein generally relate to insurance claim processing. More particularly, embodiments relate to a system and method for providing input to an insurance claim processing system using a graphical user interface. Additional embodiments relate to a system and method of tuning an insurance claim processing system.
2. Description of the Related Art
Insurance companies have been processing and settling claims associated with bodily injury for a long time. The task of evaluating, analyzing or estimating the amount of damage associated with one or more types of bodily injuries, especially trauma-induced bodily injuries, can be very complex. Complexity in the evaluation process often arises out of the fact that concurrent expertise in legal, medical and insurance fields is often required to arrive at a particular decision involving a bodily injury claim.
Several factors can affect the estimated amount of the claim associated with a bodily injury. Every accident is different and every injury is unique. Arriving at a customized evaluation of a bodily injury claim, which is unique for a specific accident, injury, etc. is desirable. Applying across-the-board standards may tend to result in an inequitable solution for one or more parties involved. External environmental factors, such as the experience level of a claims adjuster, record of accomplishment of the legal professionals, post-injury quality of life for the injured party, etc., all may affect the valuation of a claim.
During the past several years, many insurance companies have been using computer-based and knowledge-based claim-processing systems to process, evaluate, analyze and estimate thousands of claims in what is believed to be a fair and consistent manner. A knowledge-based claim-processing system may include an expert system which utilizes and builds a knowledge base to assist the user in decision making. Such a system may allow the insurance companies to define new business rules and/or use previously defined rules, in real-time. The business rules are generally written by industry experts to evaluate legal, medical, insurance conditions before arriving at a valuation of a claim.
An insurance claim processing system may determine valuation of a claim by first determining the severity of the claim. Several measures of severity of a claim may include, but are not limited to trauma severity values and bodily impairment values. Claim severity may be associated with a monetary amount. In some instances, different zones or geographic regions (e.g., different states within the United States) may have different monetary values associated with claims of the same severity (e.g., claims having the same bodily impairment, trauma severity values, etc.).